Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

Yusuke Watanabe, Ken Kozuma, Hirofumi Hioki, Hideyuki Kawashima, Yugo Nara, Akihisa Kataoka, Fukuko Nagura, Makoto Nakashima, Shinichi Shirai, Norio Tada, Motoharu Araki, Kensuke Takagi, Futoshi Yamanaka, Masanori Yamamoto, Kentaro Hayashida

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. Results A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Conclusions Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR.

Original languageEnglish
Pages (from-to)2210-2216
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume9
Issue number21
DOIs
Publication statusPublished - 2016 Nov 14

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Bundle-Branch Block
Patient Rights
Mortality
Transcatheter Aortic Valve Replacement
Kaplan-Meier Estimate
Proportional Hazards Models
Prostheses and Implants
Registries
Electrocardiography
Outpatients

Keywords

  • cardiac death
  • RBBB
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve. / Watanabe, Yusuke; Kozuma, Ken; Hioki, Hirofumi; Kawashima, Hideyuki; Nara, Yugo; Kataoka, Akihisa; Nagura, Fukuko; Nakashima, Makoto; Shirai, Shinichi; Tada, Norio; Araki, Motoharu; Takagi, Kensuke; Yamanaka, Futoshi; Yamamoto, Masanori; Hayashida, Kentaro.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 21, 14.11.2016, p. 2210-2216.

Research output: Contribution to journalArticle

Watanabe, Y, Kozuma, K, Hioki, H, Kawashima, H, Nara, Y, Kataoka, A, Nagura, F, Nakashima, M, Shirai, S, Tada, N, Araki, M, Takagi, K, Yamanaka, F, Yamamoto, M & Hayashida, K 2016, 'Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve', JACC: Cardiovascular Interventions, vol. 9, no. 21, pp. 2210-2216. https://doi.org/10.1016/j.jcin.2016.08.035
Watanabe, Yusuke ; Kozuma, Ken ; Hioki, Hirofumi ; Kawashima, Hideyuki ; Nara, Yugo ; Kataoka, Akihisa ; Nagura, Fukuko ; Nakashima, Makoto ; Shirai, Shinichi ; Tada, Norio ; Araki, Motoharu ; Takagi, Kensuke ; Yamanaka, Futoshi ; Yamamoto, Masanori ; Hayashida, Kentaro. / Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 21. pp. 2210-2216.
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abstract = "Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. Results A total of 102 patients (13.6{\%}) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6{\%} vs. 2.9{\%}; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95{\%} confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Conclusions Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR.",
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T1 - Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

AU - Watanabe, Yusuke

AU - Kozuma, Ken

AU - Hioki, Hirofumi

AU - Kawashima, Hideyuki

AU - Nara, Yugo

AU - Kataoka, Akihisa

AU - Nagura, Fukuko

AU - Nakashima, Makoto

AU - Shirai, Shinichi

AU - Tada, Norio

AU - Araki, Motoharu

AU - Takagi, Kensuke

AU - Yamanaka, Futoshi

AU - Yamamoto, Masanori

AU - Hayashida, Kentaro

PY - 2016/11/14

Y1 - 2016/11/14

N2 - Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. Results A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Conclusions Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR.

AB - Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. Results A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Conclusions Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR.

KW - cardiac death

KW - RBBB

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